1.

Definition of edema and its content

a. Fluid in the interstitial tissue space or body cavities; hydrothorax, hydroperitoneum,

hydropericardium, hydrocele

2. What do u call severe and generalized edema?

a. Anasarca

3. Pathophysiology: about the normal hydrostatic pressure and what is the function of the
hydrostatic pressure

a. normal hydrostatic pressure in the arterial end drives fluid from the lumen of the blood
into the interstitial space

4. normal function sa plasma colloid osmotic pressure

a. it will absorb back the fluid in the venous end of the capillary

5. what is the function of the lymphatics

a. small amount of extra fluid in the interstitial space is absorbed by the lymphatic. thoracic
duct >then to the left subclavian vein > the blood circulation

6. when u have disturbance from normal hydrostatic pressure, osmotic pressure, and lymphatic
pressure like increased in hydrostatic pressure, decreased in osmotic pressure, and lymphatic
obstruction, what will happen?

a. Will promote edema

b. Note: increased in hydrostatic pressure = edema

7. Give examples of a local increased in hydrostatic pressure

a. Deep vein thrombosis in le, external pressure

b. Note: kung mo ingon si Doc na conditions, clinical conditions, or example kay disease
ang iya pasabot ani

8. Effect of deep vein thrombosis

a. Localized edema of the le

9. Mechanism behind the deep vein thrombosis

a. Because of increase in hydrostatic pressure

10. What will cause the generalized increased in hydrostatic pressure

a. Congestive heart failure and constrictive mechanism

11. Effect of generalized increased in hydrostatic pressure

a. Systemic edema
12. Give a clinical example of clinical condition that will produce a local increased in the hydrostatic
pressure
- Deep vein thrombosis in the le and external pressure

13. What is the effect of deep vein thrombosis in the le

- Localized edema of the le

14. Give a clinical condition producing generalized increase in hydrostatic pressure

- Congestive heart failure, constrictive pericarditis

15. Give the most common condition

- Congestive heart failure

- Note: wala na daw labot ang steps kay malibog na dadw

16. What is the effect when u have generalized increased in hydrostatic pressure
- ???

17. What will happen to the plasma colloid osmotic pressure to produce edema
- When the plasma colloid osmotic pressure decreases

18. How is the plasma colloid osmotic pressure. What will happen to the plasma colloid osmotic
pressure
- Produce edema

19. When do u see decreased in plasma colloid osmotic pressure (clinical condition ang pasabot ni
Doc ani)
- Nephrotic syndrome, liver cirrhosis, malnutrition

20. What is the common denominator if these 3 diseases (nephrotic syndrome, liver cirrhosis,
malnutrition)
- Hypoproteinemia

- Note: hypo = low, protein, emia = blood; low protein in the blood

21. What maintains the colloid osmotic pressure

- ???

22. When there is decrease synthesis of albumin, what will happen?

- Decrease of the plasma colloid osmotic pressure

23. What will happen to the lymphatics to produce edema?

- When there is obstruction to the lymphatics

24. Give clinical conditions to produce lymphatic obstruction

- Inflammatory, neoplastic, postsurgical, post irradiation

25. What are the 3 abnormalities that will bring about edema
- Increased in hydrostatic pressure, reduced plasma colloid osmotic pressure, and lymphatic
obstruction.
Note: if seen in the naked eye = gross, not seen in the eye = microscope. Morphology of the edema mas
appreciated grossly on the legs due to gravity

26. Where is edema commonly found

- Subcutaneous tissue, lungs, brain. (including solid organs)
- If naa sa solid organs kay di mo hupong, but increase sa size and weight of the organ. Know the
normal weight of the organ before concluding that there and is edema on the solid organs.

27. Where can u find if naa siya sa subcutaneous ang edema

- Dependent parts of the body (legs = stand up, sacrum = lie down)
- In the eyes, the water will accumulate In the area wherein the connective tissue matrix is loose
o It is called the periorbital edema

28. If it occurs in the lungs

- It is called the pulmonary edema

29. What clinical conditions will produce pulmonary edema

- Left ventricular failure, renal failure, adulty respiratory distress syndrome, pulmonary infections,
hypersensitivity reaction

30. What condition will produce localized brain edema

- Abscess, neoplasm or tumors

31. What conditions will produce generalized brain edema

- Encephalitis, hypertensive crisis, obstruction to brain’s venous outflow

32. When u see both localized and generalized (referring to brain edema)
- Trauma

33. What will the brain looked grossly if there is an edema

- Swollen

34. Swollen is in the form of what

- Narrowing of the sulci and flattening of the gyri

35. What is dreaded complication in brain edema

- Brain herniation

36. What will happen if u have arteriolar dilatation

- More increased in blood flow

37. Give a clinical condition that will produce hyperemia

- Skeletal muscle during exercise, sites of acute inflammation

38. Give a physiologic condition that will give u hyperemia

- Skeletal muscle during exercise causing your skeletal muscle to turn red

Note: acute inflammation kay more on pathologic condition,

39. What is the cause of hyperemia

- Increased blood flow bec of arteriolar dilatation
 Hyperemia is an active process

40. What is the cause of congestion

- Impaired venous outflow from the tissue

41. What will happen with the blood gets stuck in the vein
- The tissue will appear cyanotic

42. Give the differentiating point between hyperemia from congestion (referring sa cause)
- Arteriolar dilatation (increase blood flow to the tissue) = hyperemia, impaired venous outflow =
congestion
- how the tissue will look (2nd point): hyperemia= mo red ang tissue, congestion = blue-red or
cyanotic

43. Clinical condition that will give rise to congestion

- cardiac failure, venous obstruction

!!!!MEMORIZE THE MORPHOLOGY BETWEEN ACUTE AND CHRONIC SA PULMONARY AND SA LIVER!!!

44. What is hemorrhage and why is there hemorrhage

- extravasation of blood due to the ruptured blood vessel

45. 3 sizes of hemorrhage

- petechiae, purpura, ecchymoses

46. What is petechiae

- *minute???* 1-2 mm hemorrhage into the skin mucous membrane or serosal surfaces

47. When do u see petechiae

- Increased intravascular pressure
- Rupture
- Platelet count (even platelet function kuan association of petechiae)
- Clotting factor defects

48. Define purpura

- Slightly larger hemorrhage, greater or equal to 3 mm

49. What is ecchymoses

- Larger, greater than 1-2 cm subcutaneous hematomas

50. When do u see ecchymoses

- After trauma

51. What is color of hemoglobin

- Red-blue

52. What is it due to (referring to hemoglobin)

- Bec of break down of RBC into to from hemoglobin

53. What is next

- From red-blue to blue-green is due to both the biliverdin and bilirubin
 54. Gold-brown in color, what is it due to
- Hemosiderin

55. Why is it ur skin will appear red-blue

- - bec of the breakdown of the ??? to form hemoglobin

56. What is responsible for the blue-green color

- Due to biliverdin and bilirubin

57. Before healing, why will it appear golden yellow

- Bec of hemosiderin

58. Accumulation of blood, what is the prefix

- Hemo

59. Prefix for edema

- Hydro

!!! study the hydrothorax, hydropercardium, and etc @2!!!

60. Blood in the thoracic cavity, what is it called

- Hemothorax

61. Blood in the pericardium

- Hemopericardium

62. Blood in the peritoneum

- Hemoperitoneum

63. Blood in the joints

- Hemarthrosis

64. Blood in the scrotal sac

- Hemocele

65. What is the clinical significance of hemorrhage

- Depends on the volume and rate of blood loss, site, iron loss

66. What is dreaded complication of hemorrhage

- Brain herniation

67. When u have subcutaneous bleeding, is it serous or not

- Not serious

- Note: the subcutaneous tissue will produce bruise

68. When u have bleeding in ur organs or brain, is it serious or not

- Serious
* no need to know the know the sequence, just know the 3 components of thrombus (clot)
formation *
69. Three components of thrombus (clot) formation
- Vascular wall endothelium
- Platelets
- Coagulation cascade
70. 3 main factors of thrombus formation or what is Virchow’s triad that may predispose to
thrombus formation
- Endothelial injury
- Alterations in normal blood flow
- Hypercoagulability of blood
71. When do u see endothelial injury
- Seen in trauma or inflammation
72. Examples of alteration in normal blood flow
- It is in the form of stasis and turbulence
- Note: when u have static flow, it will produce thrombus formation, turbulent flow and
endothelial injury prone to thrombus formation
73. When u have increase concentration of fibrinogens and is prone to thrombus formation
- Hypercoagulability of blood
74. Thrombosis occurs in
- Any place in the circulatory system: cardiac chambers, heart valves, arteries, veins,
capillaries
75. Kung mo ask si doc ug thrombus or thrombi
- Living clot
- Note: it has to be differentiated from post-mortem clot
76. One differentiating point
- Living clot has a point of attachment to the vessel wall but a post-mortem clot usually do
not have point of attachment to the vessel wall
- Living clot’s color is usually pinkish while a post-mortem clot is usually dark red in color
77. What is the composition of thrombus
- Platelets
- Fibrins
- Degenerating leukocytes
- Entrapped RBC
78. When it is formed in the heart chamber or large blood vessels, the clot will be arranged
in a laminated pattern called
- Lines of Zahn
79. Why are lines of Zahn formed
- Bec they are produced by alternating pale layer
80. These pale layers are composed of what
- Platelets and fibrins
- Note: that is why mo appear ug pale ang clot and its alternating darker layer bec of more
RBC
81. Thrombi whether form in the artery or in the veins are called
- Occlusive
82. Tell me, in descending order, where are thrombi are mostly formed
- Coronary artery
- Cerebral artery
- Femoral artery
83. It can also form in (referring above)
- Veins
84. Another term for venous thrombosis
- Phlebothrombosis
o It is also occlusive
85. Where do u find thrombus formation in the veins
- Commonly found in the deep veins of the lower extremities *bec it will undergo
embolization to other parts of the body esp to the pulmonary vasculature to produce
pulmonary thrombi embolism* (can also be found in superficial veins but di kayo
dangerous)

86. What are the Fate of the thrombus

- Propagation
- Embolization
- Dissolution
- Organization and Recanalization
87. Define propagation
- Its due to accumulation of more platelets and fibrins to make the clot enlarge as to as
produce vessel obstruction
88. What is embolization
- The thrombi that is found at the point of origin may dislodge and may fragment and it is
carried by the circulatory system to other site of the blood vessels
89. The clot that is formed in the site that is *something huhuhu di nako masabtan* from
the point of origin is called
- Embolus/emboli
90. Another fate is that it will undergo dissolution, why
- It will be dissolved by the fibrinolytic system, it will be removed by the fibrinolysis.
91. What is organization
- These are ingrowth of granulation tissue from the vessel wall
92. What is recanalization
- Within the clot, there is a development of new blood vessels as to re-established blood
flow
93. What then is clinical importance of Thrombus
- It may cause obstruction of arteries and veins
- These are source of emboli
94. What are emboli
- From thrombus then embolus
- It can either be in a solid, liquid, gaseous form
95. Where do u find embolism
- 99% from the dislodged thrombus
o Given the term thromboembolism
96. Some rare forms of emboli
- Droplets of fats
- Bubbles of air or nitrogen
- Tumor fragments
- Bits of bone marrow
97. Where will this deep vein thrombi go
- It will form emboli
98. What group will it take (?)
- It will go the pulmonary vascular (???) to produce pulmonary thromboembolism
- Note: small = silent, massive = cause sudden death
99. Where do we find fat embolism
- From fractures of long bones
 o Fat marrow
▪ Mo fracture ang long bones, fats will travel by circulation and will form fat
globules
o Hematopoietic marrow – blood elements
100. Where do u find air embolism
- Clinical significance of air embolism
o Chest wall injuries
o Obstetric procedures or laparoscopic procedures
- Seen in individuals exposed to sudden changes in atmospheric pressure
101. Who are these individuals that are exposed to changes in atmospheric pressures
- Scuba or deep sea divers
- Individuals working underwater bridge construction
- Airplane crews
102. What is the disease that will be produced
- Decompression sickness
o Another form is caisson disease (chronic form of decompression sickness)
103. Decompression sickness
- When you scuba dive with compressed air, you take in extra oxygen and nitrogen. Your
body uses the oxygen, but the nitrogen is dissolved into your blood, where it remains during
your dive. As you swim back toward the surface after a deep dive, the water pressure around
you decreases.
If this transition occurs too quickly, the nitrogen does not have time to clear from your blood.
Instead, it separates out of your blood and forms bubbles in your tissues or blood. It is these
nitrogen bubbles that cause decompression sickness. The condition is called the bends because
the joint and bone pains can be so severe they double you over.
ADD TREATMENT FOR COMPRESSION SICKNESS
- compression chamber
How will an individual that is seen in the deep sea and during rapid ascends developed air
embolism (di ko sure if kani na part)
- The nitrogen will expand to the tissue and will bubble out of the solution in the blood to
form gas emboli
104. What are bends
- These are gas bubbles that are found in the skeletal muscles and supporting tissue that
are found in and about the joints
- It is painful
 105. Chronic form of decompression sickness
- Caisson disease
106. Give clinical manifestation of air embolism
- Bends
- Chokes
107. What are chokes
- In the pulmonary vasculature, when u have gas bubbles within the pulmonary
vasculature in the lungs and the lungs will developed edema, hemorrhage, or focal
atelectasis or emphysema leads to respiratory distress
*disregard the treatment*
108. Chronic form of decompression sickness
- Caisson disease
o Persistence of gas emboli in the skeletal system leads to ischemic necrosis
109. Sites that caisson diseases are commonly found
- Heads of femur, tibia, and hunerus
110. What is amniotic fluid embolism
- These are complications during labor
111. What is the complication of labor and the immediate postpartum period, what type
embolism
- Amniotic fluid embolism
112. Why do u have amniotic fluid embolism
- When there is a disturbance/tear in the placental membrane or rupture of the uterine
vein, there would be an infusion of amniotic fluid or fetal tissue into the maternal
circulation
*skip ang clinical aspect*
113. How do u know that it is amniotic fluid embolism
- Within the pulmonary circulation, u can find squa. cells shed from fetal skin, lanugo hair,
fat from vernix caseosa, and mucin from fetal respiratory tract,GIT
*di na daw included ang last statement*
114. Where are thrombi formed?
A. Arterial or Cardiac thrombi usu. Begin at a site of endothelial injury, turbulence in vessel
bifurcation (e.g. atherosclerotic plaque)
B. Venous thrombi occur in sites of stasis
115. What is characteristics of all thromboses?
 - An area of attachment to the underlying vessel or heart wall, freq. firmest at the point of
origin.
116. Where is it formed (line of zahn)
- In the heart chambers or aorta
117. What is the significance of lines of zahn
- Thrombosis at a site of blood flow
118.Differentiate living clots from post-mortem clots
- LC pinkish in color vs PMC dark red in color
o Asa dapit ang dark red na part
▪ Naa sa ubos sa clot after it will appear yellow chicken fat supernatant
resembling melted and clotted chicken fat
- LC granular in consistency vs PMC gelatinous
- LC attached to the underlying wall vs PMC not attached to the underlying wall
119.What are the conditions that may predispose to thrombi in the cardiac chamber
- Arrythmia
- Dilated cardiomyopathy
- Heart attack or myocardial infraction
120.What are the clinical conditions that will produce thrombi in the aorta
- Ulcerated atherosclerotic plaque
- Aneurysm/ aneurysmal dilation
121.Definition of Infraction
- It is an area of ischemic necrosis
122.What is the cause of infraction
- 99% from arterial occlusion
123.Types of infracts (1 and 2 only)
- Red or hemorrhagic infract
- White or anemic infract
124.Red or hemorrhagic infract (arterial and venous occlusion)
- Usually found in loose tissue like the lungs, dual circulations like in the lungs and small
intestine, or venous occlusion like ovarian torsion
125. White or anemic infract (arterial occlusion)
 - In solid organs like the heart, liver, spleen, kidneys
126.When do u see shock/ in what medical conditions will produced shock
- Severe hemorrhage
- Extensive trauma or burns
- Large myocardial infraction
- Massive pulmonary embolism
- Microbial sepsis
127.Another term for shock
- Cardiovascular collapse
Note: when u say shock it means there is systemic hypoperfusion, reduction in cardiac output or
reduction in the effective circulating blood volume
128.What is the result (referring above)
- There would hypotension followed by impaired/decrease perfusion and cellular hypoxia
129.Types of shock
- Cardiogenic
- Hypovolemic
- Septic
130.What are examples that will give rise to cardiogenic shock
- Myocardial infraction
- Rupture of the heart
- Arrythmias
- Cardiac tamponade
- Pulmonary embolism
131.What are the examples that will give rise to hypovolemic shock
- Severe Hemorrhage
- Severe Fluid loss
132.What are examples that will give rise to septic shock
- Overwhelming bacterial infection
- Overwhelming fungal infection
133.When do u seen neurogenic shock
- Anesthetic accident or SCI
134.Anaphylactic shock
- Severe allergy
135.Clinical manifestations
- Hypotension
- Weak rapid pulse until di na ma palpable ang pulse
- Sige ka go down ang blood pressure
- Tachypnea
- Cool, clammy, pale, or cyanotic skin